SPECIALTY QUALIFICATION TRAINING RECORD (SQTR) Agency Liaison - Level 1
NAME (Last, First, MI) CAPID DATE ISSUED
Prerequisites
Item Date Completed
Qualified Agency Liaison 2
The above listed member has completed the required prerequisite training for the agency liaison - level 1 specialty. ________________________________________ ____________________
UNIT/WING/REGION COMMANDER OR DATE AUTHORIZED DESIGNEE’S SIGNATURE
Familiarization and Preparatory Training Task
Evaluator’s CAPID and Date Completed Complete NIIMS G196 or equivalent
The above listed member has completed the required familiarization and preparatory training requirements for the agency liaison - level 1 specialty qualification and is authorized to serve in that specialty while supervised on training or actual missions.
________________________________________ ____________________
UNIT/WING/REGION COMMANDER OR DATE
AUTHORIZED DESIGNEE’S SIGNATURE
Advanced Training Task
Evaluator’s CAPID and Date Completed Complete the appropriate portion of CAPT 117, Emergency Services
Continuing Education examinations
Exercise Participation
The above listed member satisfactorily participated as an agency liaison - level 1 trainee under my direct supervision on mission number ____________________.
________________________________________ ____________________ QUALIFIED SUPERVISOR’S SIGNATURE DATE
The above listed member satisfactorily participated as a lgency liaison - level 1 trainee under my direct supervision on mission number ____________________.
________________________________________ ____________________ QUALIFIED SUPERVISOR’S SIGNATURE DATE
Unit Certification and Recommendation
The above listed member has completed the requirements for the agency liaison - level 1 specialty qualification and is authorized to serve in that specialty on training or actual missions.
________________________________________ ____________________
UNIT/WING/REGION COMMANDER OR DATE
AUTHORIZED DESIGNEE’S SIGNATURE
SPECIALTY QUALIFICATION TRAINING RECORD (SQTR) Agency Liaison – Level 2
NAME (Last, First, MI) CAPID DATE ISSUED
Prerequisites
Item Date Completed
Qualified Agency Liaison 3
The above listed member has completed the required prerequisite training for the agency liaison - level 2 specialty. ________________________________________ ____________________
UNIT/WING/REGION COMMANDER OR DATE AUTHORIZED DESIGNEE’S SIGNATURE
Familiarization and Preparatory Training Task
Evaluator’s CAPID and Date Completed Complete NIIMS G195 or equivalent
The above listed member has completed the required familiarization and preparatory training requirements for the agency liaison - level 2 specialty qualification and is authorized to serve in that specialty while supervised on training or actual missions.
________________________________________ ____________________
UNIT/WING/REGION COMMANDER OR DATE
AUTHORIZED DESIGNEE’S SIGNATURE
Advanced Training Task
Evaluator’s CAPID and Date Completed Complete the appropriate portion of CAPT 117, Emergency Services
Continuing Education examinations
Exercise Participation
The above listed member satisfactorily participated as an agency liaison - level 2 trainee under my direct supervision on mission number ____________________.
________________________________________ ____________________ QUALIFIED SUPERVISOR’S SIGNATURE DATE
The above listed member satisfactorily participated as a agency liaison - level 2 trainee under my direct supervision on mission number ____________________.
________________________________________ ____________________ QUALIFIED SUPERVISOR’S SIGNATURE DATE
Unit Certification and Recommendation
The above listed member has completed the requirements for the agency liaison - level 2 specialty qualification and is authorized to serve in that specialty on training or actual missions.
________________________________________ ____________________
UNIT/WING/REGION COMMANDER OR DATE
AUTHORIZED DESIGNEE’S SIGNATURE
SPECIALTY QUALIFICATION TRAINING RECORD (SQTR) Agency Liaison – Level 3
NAME (Last, First, MI) CAPID DATE ISSUED
Prerequisites
Item Date Completed
Qualified Operations Section Chief
The above listed member has completed the required prerequisite training for the agency liaison - level 3 specialty. ________________________________________ ____________________
UNIT/WING/REGION COMMANDER OR DATE AUTHORIZED DESIGNEE’S SIGNATURE
Familiarization and Preparatory Training Task
Evaluator’s CAPID and Date Completed Complete NIIMS G193 or equivalent
The above listed member has completed the required familiarization and preparatory training requirements for the agency liaison - level 3 specialty qualification and is authorized to serve in that specialty while supervised on training or actual missions.
________________________________________ ____________________
UNIT/WING/REGION COMMANDER OR DATE
AUTHORIZED DESIGNEE’S SIGNATURE
Advanced Training Task
Evaluator’s CAPID and Date Completed Complete Task C-4000 Demonstrate the ability to select an incident staff
Complete Task C-4001 Demonstrate ability to complete an ICS Form 201 Complete Task C-4002 Demonstrate ability to develop and approve an incident Action Plan (ICS Forms 202-206 with attachments) Complete Task C-4003 Demonstrate ability to closeout a mission including completion of ICS Form 115
Complete Task C-4004 Demonstrate the ability to conduct a major incident briefing
Complete Task C-4005 Demonstrate the ability to coordinate with other agencies
Complete Task C-4130 Demonstrate the ability to select and establish a suitable staging area
Complete Task P-0101 Demonstrate ability to keep a log Complete Flight Release Officer training
Complete the appropriate portion of CAPT 117, Emergency Services Continuing Education examinations
The above listed member has completed the required familiarization and preparatory training requirements for the (insert specialty name) specialty qualification and is authorized to serve in that specialty while supervised on training or actual missions.
________________________________________ ____________________
UNIT/WING/REGION COMMANDER OR DATE
AUTHORIZED DESIGNEE’S SIGNATURE
Exercise Participation
The above listed member satisfactorily participated as an agency liaison - level 3 trainee under my direct supervision on mission number ____________________.
________________________________________ ____________________ QUALIFIED SUPERVISOR’S SIGNATURE DATE
The above listed member satisfactorily participated as an agency liaison - level 3 trainee under my direct supervision on mission number ____________________.
________________________________________ ____________________ QUALIFIED SUPERVISOR’S SIGNATURE DATE
Unit Certification and Recommendation
The above listed member has completed the requirements for the agency liaison - level 3 specialty qualification and is authorized to serve in that specialty on training or actual missions.
________________________________________ ____________________
UNIT/WING/REGION COMMANDER OR DATE
AUTHORIZED DESIGNEE’S SIGNATURE
SPECIALTY QUALIFICATION TRAINING RECORD (SQTR) Air Operations Branch Director
NAME (Last, First, MI) CAPID DATE ISSUED
Prerequisites
Item Date Completed
Qualified GES
Qualified SAR/DR Mission Pilot or Mission Observer (need not be current)
The above listed member has completed the required prerequisite training for the air operations branch director specialty. ________________________________________ ____________________
UNIT/WING/REGION COMMANDER OR DATE AUTHORIZED DESIGNEE’S SIGNATURE
Familiarization and Preparatory Training Task
Evaluator’s CAPID and Date Completed Complete NIIMS G193 or equivalent
Demonstrate knowledge Air Operations Branch Director responsibilities
The above listed member has completed the required familiarization and preparatory training requirements for the air operations branch director specialty qualification and is authorized to serve in that specialty while supervised on training or actual missions.
________________________________________ ____________________
UNIT/WING/REGION COMMANDER OR DATE
AUTHORIZED DESIGNEE’S SIGNATURE
Advanced Training Task
Evaluator’s CAPID and Date Completed Complete Task O-4052 Demonstrate ability to establish briefing areas for
crews
Complete Task O-4056 Demonstrate ability to brief aircrews for missions Complete Task O-4057 Demonstrate ability to verify that aircrews are properly equipped
Complete Task O-4062 Demonstrate ability to process a clue Complete Task O-4063 Demonstrate ability to locate or process an overdue ground team or aircrew
Complete Task O-4070 Demonstrate ability to coordinate with ground branch
Complete Task O-4071 Monitor weather throughout the operating area Complete Task O-4073 Demonstrate ability to prepare applicable portions of the CAPF 104
Complete Task O-4074 Demonstrate ability to complete a CAPF 107 Complete Task O-4078 Demonstrate ability to monitor air operations Complete Task O-4082 Prepare an ICS Form 220
Complete Task P-0101 Demonstrate the ability to keep a log Complete Basic Communications User Training
Complete Flight Release Officer Training
Complete the appropriate portion of CAPT 117, Emergency Services Continuing Education examinations
Exercise Participation
The above listed member satisfactorily participated as an air operations branch director trainee under my direct supervision on mission number ____________________.
________________________________________ ____________________ QUALIFIED SUPERVISOR’S SIGNATURE DATE
The above listed member satisfactorily participated as an air operations branch director trainee under my direct supervision on mission number ____________________.
________________________________________ ____________________ QUALIFIED SUPERVISOR’S SIGNATURE DATE
Unit Certification and Recommendation
The above listed member has completed the requirements for the air operations branch director specialty qualification and is authorized to serve in that specialty on training or actual missions.
________________________________________ ____________________
UNIT/WING/REGION COMMANDER OR DATE
AUTHORIZED DESIGNEE’S SIGNATURE
SPECIALTY QUALIFICATION TRAINING RECORD (SQTR) Communications Unit Leader
NAME (Last, First, MI) CAPID DATE ISSUED
Prerequisites
Item Date Completed
Qualified Mission Radio Operator
Complete Advanced Communications User Training
The above listed member has completed the required prerequisite training for the communications unit leader specialty. ________________________________________ ____________________
UNIT/WING/REGION COMMANDER OR DATE AUTHORIZED DESIGNEE’S SIGNATURE
Familiarization and Preparatory Training Task
Evaluator’s CAPID and Date Completed Complete NIIMS G193 or equivalent
The above listed member has completed the required familiarization and preparatory training requirements for the communications unit leader specialty qualification and is authorized to serve in that specialty while supervised on training or actual missions.
________________________________________ ____________________
UNIT/WING/REGION COMMANDER OR DATE
AUTHORIZED DESIGNEE’S SIGNATURE
Advanced Training Task
Evaluator’s CAPID and Date Completed Complete Task L-0015 Demonstrate communications planning
Complete Task L-0014 Demonstrate the ability to setup communications equipment at mission base
Complete Task L-0013 Demonstrate the ability to prepare an emergency communications plan
Complete Task L-0012 Demonstrate the ability to handle an overdue radio check-in
Complete Task L-0010 Demonstrate communication safety procedures Complete Task L-0011 Demonstrate the ability to run an emergency communications network
Complete Task L-0016 Demonstrate ability to manage radio operations for a ground net
Complete Task L-0001 Basic Communications Procedures for ES Operations
Complete Task P-0101 Demonstrate the ability to keep a log
Complete the appropriate portion of CAPT 117, Emergency Services Continuing Education examinations
Exercise Participation
The above listed member satisfactorily participated as a communications unit leader trainee under my direct supervision on mission number ____________________.
________________________________________ ____________________ QUALIFIED SUPERVISOR’S SIGNATURE DATE
The above listed member satisfactorily participated as a communications unit leader trainee under my direct supervision on mission number ____________________.
________________________________________ ____________________ QUALIFIED SUPERVISOR’S SIGNATURE DATE
Unit Certification and Recommendation
The above listed member has completed the requirements for the communications unit leader specialty qualification and is authorized to serve in that specialty on training or actual missions.
________________________________________ ____________________
UNIT/WING/REGION COMMANDER OR DATE
AUTHORIZED DESIGNEE’S SIGNATURE
SPECIALTY QUALIFICATION TRAINING RECORD (SQTR) Finance/Admin Section Chief
NAME (Last, First, MI) CAPID DATE ISSUED
Prerequisites
Item Date Completed
Qualified GES
At least 21 years of age
The above listed member has completed the required prerequisite training for the finance/admin section chief specialty. ________________________________________ ____________________
UNIT/WING/REGION COMMANDER OR DATE AUTHORIZED DESIGNEE’S SIGNATURE
Familiarization and Preparatory Training Task
Evaluator’s CAPID and Date Completed Complete NIIMS G193 or equivalent
The above listed member has completed the required familiarization and preparatory training requirements for the finance/admin section chief specialty qualification and is authorized to serve in that specialty while supervised on training or actual missions.
________________________________________ ____________________
UNIT/WING/REGION COMMANDER OR DATE
AUTHORIZED DESIGNEE’S SIGNATURE
Advanced Training Task
Evaluator’s CAPID and Date Completed Complete Task F-4100 Demonstrate the ability to provide financial and
cost analysis information as requested
Complete Task F-4102 Demonstrate the ability to determine the need to setup and operate an incident commissary
Complete Task F-4103 Demonstrate the ability to keep and transmit as necessary all personnel and equipment time records to appropriate agencies
Complete Task F-4104 Demonstrate the ability to provide financial input to the demobilization plan
Complete Task F-4105 Demonstrate preparation of all obligation documents for the incident commander
Complete Task L-0001 Basic Communications Procedures for ES Operations
Complete Task P-0101 Demonstrate the ability to keep a log
Complete the appropriate portion of CAPT 117, Emergency Services Continuing Education examinations
Exercise Participation
The above listed member satisfactorily participated as a finance/admin section chief trainee under my direct supervision on mission number ____________________.
________________________________________ ____________________ QUALIFIED SUPERVISOR’S SIGNATURE DATE
The above listed member satisfactorily participated as a finance/admin section chief trainee under my direct supervision on mission number ____________________.
________________________________________ ____________________ QUALIFIED SUPERVISOR’S SIGNATURE DATE
Unit Certification and Recommendation
The above listed member has completed the requirements for the finance/admin section chief specialty qualification and is authorized to serve in that specialty on training or actual missions.
________________________________________ ____________________
UNIT/WING/REGION COMMANDER OR DATE
AUTHORIZED DESIGNEE’S SIGNATURE
SPECIALTY QUALIFICATION TRAINING RECORD (SQTR) Ground Branch Director
NAME (Last, First, MI) CAPID DATE ISSUED
Prerequisites
Item Date Completed
Qualified General Emergency Services
Qualified Ground Team Leader (need not be current)
The above listed member has completed the required prerequisite training for the ground branch director specialty. ________________________________________ ____________________
UNIT/WING/REGION COMMANDER OR DATE AUTHORIZED DESIGNEE’S SIGNATURE
Familiarization and Preparatory Training Task
Evaluator’s CAPID and Date Completed Complete NIIMS G193 or equivalent
Demonstrate knowledge of the Ground Branch Director's responsibilities
The above listed member has completed the required familiarization and preparatory training requirements for the ground branch director specialty qualification and is authorized to serve in that specialty while supervised on training or actual missions.
________________________________________ ____________________
UNIT/WING/REGION COMMANDER OR DATE
AUTHORIZED DESIGNEE’S SIGNATURE
Advanced Training Task
Evaluator’s CAPID and Date Completed Complete Task O-4050 Demonstrate ability to coordinate with the Air
operations branch
Complete Task O-4051 Demonstrate the ability to prepare ground team briefing packets
Complete Task O-4052 Demonstrate ability to establish briefing areas for teams
Complete Task O-4054 Demonstrate ability to complete a CAPF 109 Complete Task O-4056 Demonstrate ability to brief teams for missions Complete Task O-4057 Demonstrate ability to verify that teams are properly equipped
Complete Task O-4058 Demonstrate ability to monitor ground operations Complete Task O-4077 Demonstrate the ability to verify ground teams are properly equipped.
Complete Task O-4062 Demonstrate ability to process a clue Complete Task O-4063 Demonstrate ability to locate or process an overdue ground team or aircrew
Complete Task P-0101 Demonstrate the ability to keep a log Complete Basic Communications User Training
Complete the appropriate portion of CAPT 117, Emergency Services Continuing Education examinations
Exercise Participation
The above listed member satisfactorily participated as a ground branch director trainee under my direct supervision on mission number ____________________.
________________________________________ ____________________ QUALIFIED SUPERVISOR’S SIGNATURE DATE
The above listed member satisfactorily participated as a ground branch director trainee under my direct supervision on mission number ____________________.
________________________________________ ____________________ QUALIFIED SUPERVISOR’S SIGNATURE DATE
Unit Certification and Recommendation
The above listed member has completed the requirements for the ground branch director specialty qualification and is authorized to serve in that specialty on training or actual missions.
________________________________________ ____________________
UNIT/WING/REGION COMMANDER OR DATE
AUTHORIZED DESIGNEE’S SIGNATURE
SPECIALTY QUALIFICATION TRAINING RECORD (SQTR) Incident Commander - Level 1
NAME (Last, First, MI) CAPID DATE ISSUED
Prerequisites
Item Date Completed
Qualified Incident Commander 2
The above listed member has completed the required prerequisite training for the incident commander - level 1 specialty. ________________________________________ ____________________
UNIT/WING/REGION COMMANDER OR DATE AUTHORIZED DESIGNEE’S SIGNATURE
Familiarization and Preparatory Training Task
Evaluator’s CAPID and Date Completed Complete NIIMS G193 or equivalent
Complete NIIMS G195 Complete NIIMS G196
The above listed member has completed the required familiarization and preparatory training requirements for the incident commander - level 1 specialty qualification and is authorized to serve in that specialty while supervised on training or actual missions.
________________________________________ ____________________
UNIT/WING/REGION COMMANDER OR DATE
AUTHORIZED DESIGNEE’S SIGNATURE
Advanced Training Task
Evaluator’s CAPID and Date Completed Complete the appropriate portion of CAPT 117, Emergency Services
Continuing Education examinations
Exercise Participation
The above listed member satisfactorily participated as an incident commander - level 1 trainee under my direct supervision on mission number ____________________.
________________________________________ ____________________ QUALIFIED SUPERVISOR’S SIGNATURE DATE
The above listed member satisfactorily participated as aN incident commander - level 1 trainee under my direct supervision on mission number ____________________.
________________________________________ ____________________ QUALIFIED SUPERVISOR’S SIGNATURE DATE
Unit Certification and Recommendation
The above listed member has completed the requirements for the incident commander - level 1 specialty qualification and is authorized to serve in that specialty on training or actual missions.
________________________________________ ____________________
UNIT/WING/REGION COMMANDER OR DATE
AUTHORIZED DESIGNEE’S SIGNATURE
SPECIALTY QUALIFICATION TRAINING RECORD (SQTR) Incident Commander - Level 2
NAME (Last, First, MI) CAPID DATE ISSUED
Prerequisites
Item Date Completed
Qualified Incident Commander 3
The above listed member has completed the required prerequisite training for the incident commander - level 2 specialty. ________________________________________ ____________________
UNIT/WING/REGION COMMANDER OR DATE AUTHORIZED DESIGNEE’S SIGNATURE
Familiarization and Preparatory Training Task
Evaluator’s CAPID and Date Completed Complete NIIMS G193 or equivalent
Complete NIIMS G195
The above listed member has completed the required familiarization and preparatory training requirements for the incident commander - level 2 specialty qualification and is authorized to serve in that specialty while supervised on training or actual missions.
________________________________________ ____________________
UNIT/WING/REGION COMMANDER OR DATE
AUTHORIZED DESIGNEE’S SIGNATURE
Advanced Training Task
Evaluator’s CAPID and Date Completed Complete the appropriate portion of CAPT 117, Emergency Services
Continuing Education examinations
Exercise Participation
The above listed member satisfactorily participated as a incident commander - level 2 trainee under my direct supervision on mission number ____________________.
________________________________________ ____________________ QUALIFIED SUPERVISOR’S SIGNATURE DATE
The above listed member satisfactorily participated as a incident commander - level 2 trainee under my direct supervision on mission number ____________________.
________________________________________ ____________________ QUALIFIED SUPERVISOR’S SIGNATURE DATE
Unit Certification and Recommendation
The above listed member has completed the requirements for the incident commander - level 2 specialty qualification and is authorized to serve in that specialty on training or actual missions.
________________________________________ ____________________
UNIT/WING/REGION COMMANDER OR DATE
AUTHORIZED DESIGNEE’S SIGNATURE
SPECIALTY QUALIFICATION TRAINING RECORD (SQTR) Incident Commander – Level 3
NAME (Last, First, MI) CAPID DATE ISSUED
Prerequisites
Item Date Completed
Qualified Operations Section Chief
The above listed member has completed the required prerequisite training for the incident commander - level 3 specialty. ________________________________________ ____________________
UNIT/WING/REGION COMMANDER OR DATE AUTHORIZED DESIGNEE’S SIGNATURE
Familiarization and Preparatory Training Task
Evaluator’s CAPID and Date Completed Complete NIIMS G193 or equivalent
The above listed member has completed the required familiarization and preparatory training requirements for the incident commander - level 3 specialty qualification and is authorized to serve in that specialty while supervised on training or actual missions.
________________________________________ ____________________
UNIT/WING/REGION COMMANDER OR DATE
AUTHORIZED DESIGNEE’S SIGNATURE
Advanced Training Task
Evaluator’s CAPID and Date Completed
Complete Task C-4000 Demonstrate the ability to select an incident staff Complete Task C-4001 Demonstrate ability to complete an ICS Form 201 Complete Task C-4002 Demonstrate ability to develop and approve an incident Action Plan (ICS Forms 202-206 with attachments)
Complete Task C-4003 Demonstrate ability to closeout a mission including completion of ICS Form 115
Complete Task C-4004 Demonstrate the ability to conduct major incident briefings Complete Task C-4005 Demonstrate the ability to coordinate with other agencies Complete Task C-4130 Demonstrate ability to select and establish a suitable Incident Command Post or staging area